The urban environment can affect physical activity in people with chronic obstructive pulmonary disease (COPD)

Around 35% of city residents in Europe suffer from a chronic health condition. One such condition is COPD, which is characterised by progressive obstruction of airflow into the lungs, leading to shortness of breath. This often limits patients’ ability to carry out daily activities, including exercise. And the less physical activity a person does, the more the disease progresses. It is therefore important to understand what factors—other than the disease itself—may influence physical activity in these patients.

To this end, a team led by Judith Garcia-Aymerich, Head of the Non-Communicable Diseases and Environment Programme, set out to estimate the association between the urban environment to which COPD patients are exposed and their physical activity (number of steps per day), exercise capacity (distance covered in 6 minutes of walking) and experience (perceived difficulty).

The study used data from 404 COPD patients from a multicentre study conducted in five coastal towns in Catalonia. For each patient, the researchers determined the population density and length of pedestrian streets in their neighbourhood, the slope of the terrain, and long-term exposure to traffic noise, NO2 and particulate matter (PM2.5).

In 2019, COPD affected 212 million people and caused over 3 million deaths

Four associations

A surprising finding was that higher population density was associated with lower physical activity and exercise capacity. “We tend to think that high urban density encourages walking, but when it is very high, as it is in Barcelona, it could have negative effects because of the increased dangers of traffic, fumes and noise,” says Maria Koreny, first author of the study. In this sense, NO2 levels were associated with more sedentary time and greater difficulty exercising, most likely because air pollution aggravates COPD symptoms, forcing patients to reduce exertion.

In contrast, pedestrian street length was associated with more steps and less sedentary time, and steeper slopes were associated with more steps and greater exercise capacity, probably due to a “training” effect.

“Our findings allow us to develop strategies that promote physical activity in COPD patients,” says Garcia-Aymerich. For example, advising them to walk in hilly neighbourhoods and less polluted areas. “Cities also need to be designed for the elderly and the sick,” she adds.

Koreny M, Arbillaga-Etxarri A, Bosch de Basea M, et al. Urban environment and physical activity and capacity in patients with chronic obstructive pulmonary disease. Environ Res. 2022 Nov;214:113956. doi:10.1016/j.envres.2022.113956.

Photo: Isaac Planella, Barcelona City Council